Provider Demographics
NPI:1154606853
Name:ACCESSIBLE MOBILE DENTAL HYGIENE LLC
Entity type:Organization
Organization Name:ACCESSIBLE MOBILE DENTAL HYGIENE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTAL HYGIENIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:TRIPP
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:541-295-1264
Mailing Address - Street 1:4542 AVERILL DR
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-4114
Mailing Address - Country:US
Mailing Address - Phone:541-295-1264
Mailing Address - Fax:
Practice Address - Street 1:4542 AVERILL DR
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-4114
Practice Address - Country:US
Practice Address - Phone:541-295-1264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5633261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental